PROGNOSTIC VARIABLES AFFECTING PRIMARY TREATMENT OUTCOME FOR MEDULLARY THYROID CANCER.

PROGNOSTIC VARIABLES AFFECTING PRIMARY TREATMENT OUTCOME FOR MEDULLARY THYROID CANCER.

Endocr Pract. 2017 Jul 06;:

Authors: Momin S, Chute D, Burkey B, Scharpf J

Abstract
OBJECTIVE: Identifying prognostic risk factors and determining the efficacy of common surgical treatments is critical to determine optimal treatment strategies for patients with medullary thyroid carcinoma (MTC). The objective of this study was to review a contemporary institutional experience with medullary thyroid carcinoma primary treatment with two goals: to identify prognostic factors that affect survival and to study the effect of neck dissection on those outcomes.
METHODS: This study is a retrospective case series of patients with MTC who underwent at least a total thyroidectomy with curative intent. Clinical parameters including tumor and nodal staging with corresponding pathology findings were identified. Survival endpoints included overall survival, and disease-free survival and biochemical cure.
RESULTS: Sixty seven patients were included. The majority of patients presented with early T-stage disease. Fifty patients (76%) were N0 at presentation. Seventeen patients (24%) had some evidence of neck disease on clinical examination or imaging. Forty patients (71%) achieved biochemical cure. Of those who achieved cure, 5-year biochemical recurrence free survival was 86.5%. Among patients who had successful resection of all gross disease, 92% had no evidence of structural disease at 5 years. Overall survival was 91% at 5 years. Increased pre-operative calcitonin level and primary tumor size, extrathyroidal extension and neck metastases decrease the rate of biochemical cure. Increasing tumor size increases the risk of structural disease recurrence and biochemical relapse after initial cure. The presence and number of neck metastases are correlated with biochemical relapse. The presence of lateral neck nodes (pN1b) does not have different survival implications than centrally-confined disease (pN1a).
CONCLUSION: This study shows increasing tumor size, increased calcitonin level and cervical metastases are poor prognostic factors. Patients with large tumors, high calcitonin level or unfavorable pathologic findings may warrant more aggressive initial treatment, although limitations of the study prevent any conclusion regarding the effect of neck dissection.

PMID: 28683235 [PubMed - as supplied by publisher]

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